Provider Demographics
NPI:1194762120
Name:CONWAY, STEPHEN A (MD)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:A
Last Name:CONWAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:33 BARTLETT ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1334
Mailing Address - Country:US
Mailing Address - Phone:978-452-2200
Mailing Address - Fax:978-441-2651
Practice Address - Street 1:33 BARTLETT ST
Practice Address - Street 2:SUITE 305
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1334
Practice Address - Country:US
Practice Address - Phone:978-452-2200
Practice Address - Fax:978-441-2651
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2013-01-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
RI11822208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
007058369Medicare ID - Type Unspecified